[1]潘亚伟,张丁城,周建和,等.MRI表现诊断髌骨软化症的可信性研究[J].中医正骨,2012,24(11):22-25.
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MRI表现诊断髌骨软化症的可信性研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第24卷
期数:
2012年11期
页码:
22-25
栏目:
影像诊断
出版日期:
2012-11-20

文章信息/Info

作者:
潘亚伟张丁城周建和沈晓涛潘合科
广东省东莞康华医院,广东 东莞 523080
关键词:
髌骨软骨软化症 MRI 膝前痛 关节镜
摘要:
目的:探讨MRI对髌骨软化症诊断的可靠性。方法:共纳入患有膝前疼痛经临床初步诊断为髌骨软化症的中青年病人112例,先行膝关节MRI检查,再行膝关节镜检查验证,并将MRI所示髌骨损伤情况与关节镜所见比较。结果:关节镜检查证实有膝前疼痛表现的112例患者中,存在髌骨软化者50例(45%),滑膜肥厚50例,半月板撕裂8例,股胫关节软骨损伤8例和未见形态异常者12例。1.5T MRI检出髌骨软化症的阳性率为75%(95%可信区间,53%~89%),阴性率为72%(95%可信区间,56%~84%),其敏感性为60%(95%可信区间,41%~77%),特异性为84%(95%可信区间,2%~49%),诊断准确率为73%(95%可信区间,60%~83%)。Ⅰ度损伤的敏感度为13%(95%可信区间,2%~49%),Ⅱ、Ⅲ或Ⅳ度损伤的敏感度为83%(95%可信区间,59%~94%)。结论:根据临床症状和目前物理检查方法不能诊断髌骨软化症。1.5T的MRI诊断Ⅰ度软骨损伤的敏感度较低,而对Ⅱ、Ⅲ或Ⅳ度损伤的敏感度很高。MRI检查可以作为较重髌骨软化症的一种诊断方法。

参考文献/References:

[1] Wiles P,Andress PS,Devas MB.Chondromalacia of the patella[J].J Bone Joint Surg Br,1956,38(B):95-113.
[2] Dye SF.The pathophysiology of patellofemoral pain:a tissue homeostasis perspective[J].Clin Orthop Relat Res,2005,(436):100-110.
[3] Stoller,Daviod W,Editor.Magnetic resonance imaging in orthopaedics and sports medicine[M].3rd.Baltimore:Lippincott Williams and Wilkins,2006,(1):305-732.
[4] Leslie IJ,Bentley G.Arthroscopy in the diagnosis of chondromalacia patellae[J].Ann Rheum Dis,1978,37(6):540-547.
[5] Chan WP,Lang P,Stevens MP,et al.Osteoarthritis of the knee:comparison of radiography,CT,and,MR imaging to assess extent and severity[J].AJR Am J Roentgenol,1991,(157):799-806.
[6] Wright RW,Boyce RH,Michener T,et al.Radiographs are not useful in detecting arthroscopically confirmed mild chondral damage[J].Clin Orthop Rela Res,2006,(442):245-251.
[7] Casscells SW.Arthroscopy of the knee joint.A review of 150 cases[J].J Bone Joint Surg Am,1971,53(2):287-298.
[8] Crossley K,Bennell K,Green S,et al.Physical therapy for patellofemoral pain:a randomized,double-blinded,placebo-controlled trial[J].Am J Sports Med,2002,30(6):857-865.
[9] Federico DJ,Reider B.Results of isolated patellar debridement for patellofemroal pain in patients with normal patellar alignment[J].Am J Sports Med,1997,25(2):663-669.
[10] McCauley TR,Kier R,Lynck KJ,et al.Chondromalacia patellae:diagnosis with MR imaging[J].AJR Am J Roentgenol,1992,(158):101-105.
[11] Lee SH,Suh JS,Cho J,et al.Evaluation of chondromalacia of the patella with axial inversion recovery-fast spin-echo imaging[J].J Magn Reson Imaging,2001,13(3):412-416.
[12] Macarini L,Perrone A,Murrone M,et al.Evaluation of patellar chondromalacia with MR:comparison between T2-weighted FSE SPIR and GE MTC[J].Radiol Med,2004,(108):159-171.
[13] Vanarthos WJ,pope TL Jr,Monu JU.Comparison of axial T1 spinecho and T1 fat-saturation magnetic resonance imaging techniques in the diagnosis of chondromalacia patellae[J].Orthop Rev,1994,23(12):942-946.
[14] Handelberg F,Shahabpour M,Casteleyn PP.Chondral lesions of the patella evaluated with computed tomography,magnetic resonance imaging,and arthroscopy[J].Arthroscopy,1990,6(1):24-29.
[15] Gagliardi JA,Chung EM,Chandnani VP,et al.Detection and staging of chondromalacia patellae: relative efficacies of conventional MR imaging.MR arthrography,and CT arthrography[J].AJR Am J Roentgenol,1994,163(3):629-636.
[16] Murphy BJ.Evaluation of grades 3 and 4 chondromalacia of the knee using T2-weighted 3D gradient-echo articular cartilage imaging[J].Skeletal Radiol,2001,30(6):305-311.
[17] Brown TR,Quinm SF.Evaluation of chondromalacia of the patellofemoral compartment with axial magnetic resonance imaging[J].Skeletal Radiol,1993,22(5):325-328.
[18] Laurin CA,Levesque HP,Dussault R,et al.The abnormal lateral patellofemoral angle:a diagnostic roentgenographic sign of recurrent patellar subluxation[J].J Bone Joint Surg Am,1978,60(1):55-60.
[19] Merchant AC,Mercer RL,Jacobsen RH,et al.Roentgenographic analysis of patellofemoral congruence[J].J Bone Joint Surg Am,1974,56(7):1391-1396.
[20] Suh JS,Cho JH,Shin KH,et al.Chondromalacia of the knee:evaluation with a fat-suppression three-dimensional SPGR imaging after intravenous contrast injection[J].J Magn Reson Imaging,1996,6(1):884-888.
[21] Laprade J,Culham E.Radiographic measures in subjects who are asymptomatic and subjects with patellofemoral pain syndrome[J].Clin Orthop Relat Res,2003,(414):172-182.

更新日期/Last Update: 2012-11-20